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Question 1 What is the best sedative to give as premedication for neonatal intubation?
  1. Tim J van Hasselt1,2
  1. 1 Birmingham Children’s Hospital, Birmingham, UK
  2. 2 Queen Elizabeth Hospital Birmingham, Birmingham, UK
  1. Correspondence to Dr Tim J van Hasselt, Trainee in Acute Paediatrics, Birmingham Children’s Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK; t.vanhasselt{at}nhs.net

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Scenario

A baby on the neonatal unit requires endotracheal intubation. You plan to give sedation and analgesia to reduce pain and distress, to reduce cardiovascular disturbance and to give better conditions for successful intubation. You are familiar with commonly used premedication regimens using morphine or fentanyl, but wonder if there are better alternatives.

Structured clinical question

In neonates requiring intubation (population), is there a better sedative/analgesic (intervention) than the most common premedications (fentanyl or morphine, with atropine and suxamethonium) to reduce patient distress, reduce cardiovascular instability, and either increase success rates or improve conditions for intubation (outcome)?

Search

Cochrane Library: two relevant found, the first withdrawn from the Cochrane Library1 and the second2 only examines one study by Ghanta et al.3

PubMed/Medline and Embase search: (neonat* OR newborn OR new-born) AND (pre-medication OR premedication OR induction OR sedation OR analgesia OR painkiller OR pain-killer) AND (intubation).

Abstracts obtained and reviewed, PubMed/Medline search: 574, Embase: 51; 20 additional abstracts reviewed based on references from review articles, 563 excluded as not relevant based on abstracts, 8 excluded as foreign language.

Summary

Commentary

It is now accepted that premedication should be used to reduce pain and marked physiological changes …

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